What Causes Breast Cancer?
No one knows very much about why breast cancer happens, except that it likely starts in our genes. "Cancer in general is a disease of aging, and breast cancer is probably caused by an error in gene replication—the older we get, the more error prone we get," says Ramona F. Swaby, MD, a medical oncologist specializing in breast cancer at Fox Chase Cancer Center in Philadelphia.
Indeed, a woman’s chance of getting breast cancer doesn’t rise to the terrifying one in eight until she’s reached 85 years of age. If you’re a woman under 40, for instance, your risk is much lower: one in 233.
Approximatly 5% to 10% of the roughly 200,000 American women diagnosed with breast cancer each year have an inherited gene mutation that puts them at higher risk for developing the disease. Most of these genes remain unidentified, but scientists know that mutations to the BRCA-1 and BRCA-2 (Breast Cancer 1 and 2) genes, which normally help prevent cancer by regulating cell growth, are linked to an increased risk for breast and ovarian cancer.
If you’re wondering whether you carry the BRCA-1 or BRCA-2 mutations, you may have considered getting a genetic test to find out. That’s a tough decision, because it’s not always clear what to do with your test results.
Some women who know they are at higher risk without taking the test simply commit to more frequent mammograms; others feel the need to know as much as possible and may consider prophylactic surgery if they test positive.
Lead writer: Lorie Parch
Last Updated: April 13, 2008
Should I Get Tested for the Breast and Ovarian Cancer Genes?
content provided by Healthwise
The decision whether to have a BRCA gene test takes into account your personal feelings and the medical facts.
Reasons to have a BRCA gene test
- If you tested positive, you would want to take steps to lower your chances of getting cancer.
- You need to know if your chances of getting cancer are higher because of a BRCA gene change.
- You have a strong family history of breast or ovarian cancer.
- You are Jewish and there is breast or ovarian cancer in your family.
- Your insurance covers some or all of the cost of testing.
- You want to let other relatives know if you test positive so that they can think about having the test.
Reasons to not have a BRCA gene test
- You are worried about how the test results will affect your relationships.
You would have to decide if you would tell other family members, who would then have to decide whether to be tested.
- Your insurance does not cover the testing, or it covers only part of the cost.
- You are worried about how the test results might affect your job or your health insurance or life insurance.
- You would not take steps to lower your chances of getting cancer if you tested positive.
- You do not want to know if your chances of getting cancer are higher because of a BRCA gene change.
Last Updated: April 28, 2008
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When Prophylactic Mastectomy Is a Good Option: Stories of 2 High-Risk Women
Deciding to have a mastectomy without actually having breast cancer is not necessarily the radical alternative it might appear to be.
An increasing number of high-risk women make the choice to have prophylactic mastectomy—many after testing positive for BRCA gene mutations. But the routes to this difficult decision can be quite different. • Sara Daly Roter's mother had breast cancer—and so did both of her grandmothers.
So three years ago the Manhattanite, then 27, got tested for the BRCA gene mutations. "It was scary for me, but there was no question that I wanted to know," says Roter. "I didn't think too much about it—until it came back positive."
Roter was reeling when the genetic counselor gave her the news. "It didn't sink in when she was first telling me.
She explained that I was at greater risk, that I needed to be screened earlier. She told me there were programs for high-risk women."
Roter set up a meeting with an oncologist to discuss a screening schedule—check-ups every six months—but in the end opted for prophylactic double mastectomy with immediate reconstruction, which she had in July 2007.
"For me, the surgery was a no-brainer," she says. "To be tested every six months for the rest of my life; that was too nerve-wracking. I can't live like that. It's just a matter of waiting till it finally shows up, until you're diagnosed with it."
• Liz Perri lost her mom to breast cancer—her mother was just 39—so she got the BRCA test herself when she was 26, in February 2008.
The Chicago native decided in advance that if she did have the gene mutations, she'd get a preventative double mastectomy. "If I tested positive, I knew I had to do something," says Perri.
Thankfully, the results came back negative, and Perri was able to shelve the surgery. But because of her family history, she still has a higher-than-average chance of getting breast cancer.
That's the main reason she enrolled to be part of a cutting-edge early detection program through the Lynn Sage Comprehensive Breast Center at Northwestern Memorial Hospital in Chicago.
The screening regimen involves various combinations of MRIs, mammograms, and ultrasounds every six months.
If you're from a high-risk family and are considering the BRCA test, start by reviewing the pros and cons, then discuss options with your doctor or a genetic counselor.
Lead writer: Lorie Parch
Last Updated: April 21, 2008
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